Abstract of

The use of oral opioids in patients with chronic non-cancer pain

Management strategies

Paul J Graziotti and C Roger Goucke

Background: The use of oral opioids in non-cancer pain is increasing, but it is not clear that this is improving outcomes for patients. These management strategies were developed as a consensus view between the two authors, who are both Directors of the Australian Pain Society. The strategies were subsequently reviewed and approved by the other Directors of the Society: four anaesthetists specialising in pain management, a pharmacist, a rheumatologist, two rehabilitation physicians and an occupational therapist.

Evidence base: A Medline search of the literature since 1966 produced 163 relevant articles, including two randomised controlled trials of oral opioids in non-cancer pain.

Management consensus

• A small group of patients with chronic non-cancer pain can benefit from the use of oral opioids.
  
• Thorough attention to diagnosis and patient history must precede any decision to prescribe opioids.
  
• Patients should be psychologically stable.
  
• Patient and doctor should agree beforehand on how to assess the outcome of therapy.
  
• Only one doctor (the patient's regular primary carer or pain specialist) should prescribe opioids and assess the response.
  
• Sustained release morphine preparations are the drug of choice.
  
• A trial of therapy, with goals and endpoint agreed between patient and doctor, should precede any decision to prescribe opioids in the long term.

MJA 1997; 167: 30-34

©MJA 1997

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